Access to medicines is part of the right to health, which in turn must be promoted through the adoption of public policies and, in some cases, legislative mechanisms to provide their guarantee 12, 13. Nevertheless, there is an inequity in this guarantee, which reinforces the need to strengthen the Unified Health System for the free supply of medicines to reduce inequalities 14.
Among the individuals interviewed, 84.0% of diabetic patients and 83.4% of hypertensive patients were using drug treatment. It is known that the control of both chronic diseases is based on a series of precautions, which involve nutritional changes, physical activity and control of some risk factors 15, 16. However, drug treatment becomes the most effective way to control and prevent complications of these morbidities, as adherence to lifestyle changes is always less than adherence to treatment 17. However, for this treatment to be effective, it is necessary that the user has access to it 18.
A study conducted with data from the 2011 VIGITEL survey showed a lower prevalence of medication use among diabetic and hypertensive patients, with 78.2% and 72.0%, respectively, compared to the present article 19. The National Health Survey (2013) showed that 80.2% and 81.4% used drugs to control diabetes and hypertension, respectively 20. These results suggest a progression in the use of medications for these two chronic conditions. The increase in the use of medicines for these diseases may also reflect less healthy behavior, which leads to an increase in the prevalence of hypertension and diabetes, leading to an increase in the population in need of these medicines.
The general lack of access to medicines for diabetes and hypertension was approximately 10.0%. Although the findings indicate that the constitutional right of health may be compromised by a portion of the investigated participants, it should be noted that access to antihypertensives and antidiabetics in Brazil can be considered, and this is due to a series of public policies that have been adopted to guarantee universal and free access to medicines 21.
In 1998, Brazil instituted the National Medicines Policy 8, adopting, among other guidelines, the National List of Essential Medicines 12. Subsequently, the generic medicine policy was also implemented, whose objective was to expand access to medicines with guaranteed quality and at a more affordable price for the population, and in 2004, the Popular Pharmacy Program (PFP) was created within the scope of the System Unified Health System (SUS) 22. PFP emerged with the aim of expanding access to medicines to the entire population, aiming to prevent treatment abandonment, especially in low-income individuals who have difficulties acquiring the necessary medicines in private pharmacies 23. In 2011, the program was reformulated to further increase the coverage of pharmaceutical assistance and promote comprehensive health care, changing its name to “Health is priceless”, in which medicines for the treatment of diabetes, hypertension and asthma passed to be provided free of charge 24.
When assessing access to different sources of medication, the main means of obtaining antihypertensive drugs in all regions was the private pharmacy. This finding may reflect a series of barriers that still exist, such as difficulty in accessing the consultation for renewing the prescription for withdrawing medications, lack of knowledge about the list of medications available for free, prejudice against free medications provided by the government, and geographical limitations, among others 3, 25. For diabetes medications (oral and insulin), it was observed that the North, Northeast, and Midwest regions had private pharmacies as the main means of obtaining them, suggesting regional disparities in access.
The same was observed in the National Survey on Access, Use and Promotion of Rational Use of Medicines 26, which pointed to statistically significant differences in access to essential medicines between regions of the country, as well as according to the type of medicine. A study carried out based on the VIGITEL survey (2011) showed that people who live in the capitals of Brazilian regions with less economic development and a larger socially vulnerable population are also those who most needed to make direct disbursements to access treatment for hypertension and diabetes 19, pointing out how unequal health care is in a country with continental dimensions such as Brazil.
This study highlights the difficulties of obtaining medication in the North region, which clearly demonstrates geographical inequalities when compared with the South region existing in the field of health. Accessing medication in the referred region is a challenge for the user, and for the management of services to provide it, adding to this, it also has a more peculiar condition of other regions, such as the geography of the Amazon territory. The geographical limitations that constitute barriers to access to health services can make it difficult to acquire epidemiological information and medications from certain populations, causing health problems to often be solved with the use of allopathic medication 27.
This support for inequality as a geographical difficulty in accessing medication is further strengthened when analyzing some of the different spaces for dispensing medications, such as the Family Health Strategies (FHS) 28. While the North region has family health coverage of more than 63.0%, the Southeast region has less than 54.0% 29, which converges with the hypothesis that it is not enough to guarantee dispensing structures for effective access to medication, if the ability of users or patients to get it is not taken into account, as well as the hypothesis that the distribution of health services health is not proportional to the distribution of demands 28.
Among the limitations of the study, since it is self-reported information, the memory bias of the interviewees stands out, possible differences in the understanding of some issues and the selection bias, since the survey did not include individuals living in households without a landline.